<!DOCTYPE html>
<html>
	<head>
		<meta charset="utf-8">
		<title>检查挂号信息</title>

		<link rel="stylesheet" type="text/css" href="/static/css/confirmregistration.css" />
	</head>
	<body>
		{% load static %}
		<div class="logo_box">
			<img class="logo_img" src="/static/images/patient.png" />
		</div>
		<div>
			<form class="login_box" method="POST" action="/confirmregistration/">
				<h1 class="title">挂号信息</h1>
                {% csrf_token %}
				<input class="input_box" type="text" name="patient_name" value="{{ patient_name }}" placeholder="患者姓名" />
				<input class="input_box" type="text" name="doctor_name" value="{{ doctor_name }}" readonly unselectable="on" />
				<input class="input_box" type="text" name="registration_time" value="{{ registration_time }}" readonly unselectable="on" />
				<input class="input_box" type="text" name="consultation_hours" value="{{ consultation_hours }}" readonly unselectable="on" />
				<input class="input_box" type="text" name="illness" value="" placeholder="病情概要" />
				<input class="input_box" type="text" name="address" value="{{ address }}" readonly unselectable="on" />
				<input class="input_box" type="text" name="registration_price" value="{{ registration_price }}" readonly unselectable="on" />

				<input class="input_box" type="text" name="doctor_id" value="{{ doctor_id }} " style = "display:none" />
				<input class="input_box" type="text" name="patient_id" value="{{ patient_id }} " style = "display:none" />

				<input class="button_box" type="submit" value="确认并支付" />
			</form>
		</div>
	</body>
</html>
